Healthcare Provider Details

I. General information

NPI: 1588636708
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING OF BRANDYWINE VALLEY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 E LANCASTER AVE
DOWNINGTOWN PA
19335-3357
US

IV. Provider business mailing address

1238 E LANCASTER AVE
DOWNINGTOWN PA
19335-3357
US

V. Phone/Fax

Practice location:
  • Phone: 610-518-3428
  • Fax:
Mailing address:
  • Phone: 610-518-3428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number StatePA

VIII. Authorized Official

Name: GARY D NEWSOME
Title or Position: PRESIDENT
Credential:
Phone: 888-373-9600